This Authorization Form must be completed and signed prior to the cremation. Please read it carefully and ask us any questions you may have. Cremation is an irreversible and final process. It is important that you understand the cremation process that is described in Section 8 of this Authorization Form prior to signing. We want you to fully understand the information provided in this Authorization Form, so we will be happy to answer any questions about the cremation process or any other information in this form. THIS AUTHORIZATION IS NOT A CONTRACT FOR CREMATION SERVICES. A SEPARATE CONTRACT OR CONTRACTS WILL BE REQUIRED TO PURCHASE THE SERVICES OF THE FUNERAL HOME AND/OR CREMATORY.
BECAUSE CREMATION IS IRREVERSIBLE, IDENTIFICATION OF THE DECEDENT IS REQUIRED BY ONE OF THE FOLLOWING METHODS: ***INITIAL AFTER CHOOSING A, B OR C BELOW***
The Authorizing Agent authorizes the Funeral Home & Crematory set forth below to carry out the directions and instructions of the Authorizing Agent contained in the Form.
Funeral Home Name:
Georgia Funeral Care & Cremation Services, Inc.
Funeral Home Address:
4671 S. Main St. Acworth, GA 30101
Crematory Name:
Georgia Funeral Care & Cremation Services, Inc.
Crematory Address:
4671 S. Main St. Acworth, GA 30101
As Authorizing Agent, I have reviewed the priority list in #3 (ABOVE) and I represent that I have the right to authorize the cremation of the decedent's remains and I am initialing one of the following four statements below accordingly: (CHOOSE ONE)
Initial one of the following statements: (Choose One)
The remains are to be cremated in a combustible casket or alternative container that is capable of being completely closed, is resistant to leakage or spillage, is sufficiently rigid to be handled easily, and provides protection for the health and safety of Crematory and Funeral Home personnel. The Crematory is authorized to inspect the casket or alternative container, including opening it if necessary. In the event that the casket or container does not meet the above requirements, the Crematory will notify the authorizing Agent. Many caskets are comprised primarily of combustible material also contain some exterior parts (decorative handles or rails) that are not combustible and that may cause damage to the cremation equipment. As Authorizing Agent, I authorize Crematory, in its discretion, to remove and discard the non-combustive materials. I understand that some crematories will not accept metal or fiberglass caskets. I further understand that the casket or alternative container will be consumed as part of the cremation process.
Witnessing a cremation can be an emotional experience. Witnesses are assuming the risks involved and fully release the Funeral Home and Crematory from any liability. To the extent permitted by Crematory, the persons listed on the reverse side are authorized to be present at the cremation room prior to and during the cremation of the Decedent's remains and during the removal of the cremated remains from the cremation chamber. If you desire witnesses, you must initial below and list the witness names. (CHOOSE ONE)
I have read and I understand the following:
As Authorizing Agent, I have read and understand the description of the cremation process contained in #8 in this form and authorize the cremation, processing and pulverization of the remains of the Decedent.
After the cremated remains have been processed, they will be placed in the urn listed on reverse side or, if an urn is not provided to the Crematory, a temporary container will be provided by the Crematory. The Authorizing Agent acknowledges that it is impossible to recover all the dust and residue
from the cremation and processing.
In the case of an adult, it is recommended that the urn or temporary container be a minimum size of 200 cubic inches. In the event the urn or temporary container is insufficient to accommodate all the cremated remains, the excess will be placed by the Crematory in a secondary container. This secondary container will be kept with the urn or temporary container and handled according to the final disposition instruction set forth in section 11, provided, however, that the secondary container may not be designed for shipping. All urns or containers provided to the Funeral Home or Crematory must be appropriate for shipping. The Authorizing Agent directs the Crematory to use the specified urn or container listed in #10.
PLEASE INITIAL THE OPTION SELECTED AFTER READING THE FOLLOWING: (CHOOSE ONLY ONE)
All personal property and effects delivered with the remains of the Decedent to the Funeral Home/Crematory, including jewelry, clothes, hair pieces, dental bridgework, eyeglasses, shoes, etc., will be destroyed in the cremation process or otherwise discarded by the crematory, in its sole discretion, unless specific instructions are given by the Authorizing Agent below:
Prior to the cremation of the Decedent's remains, the Authorizing Agent or decedent's family have arranged for a viewing/ceremony set forth below:
Please initial one of the following:
The Authorizing Agent acknowledges that the Funeral Home and Crematory are relying upon the representations being made by the Authorizing Agent in this Authorization. The Authorizing Agent certifies that all of the information and statements contained in the Authorization are accurate and no omissions of any material fact have been made. The Authorizing Agent agrees to indemnify and hold harmless the Funeral Home and Crematory, their officers, directors, employees and agents from any and all claims, demands, actions, causes of action or suits of any kind or nature whatsoever, including, but not limited to, any legal fees arising out of or resulting from the Funeral Home's and Crematory's reliance on or performance consistent with the directions, statements, representations, and agreements contained in the Authorization.